Endoscopy 2009; 41(2): 107-112
DOI: 10.1055/s-0028-1119469
Original article

© Georg Thieme Verlag KG Stuttgart · New York

High-definition endoscopy with i-Scan and Lugol’s solution for more precise detection of mucosal breaks in patients with reflux symptoms

A.  Hoffman1 , N.  Basting1 , M.  Goetz1 , A.  Tresch3 , J.  Mudter1 , S.  Biesterfeld2 , P.  R.  Galle1 , M.  F.  Neurath1 , R.  Kiesslich1
  • 1I Med Clinic, Johannes Gutenberg University Mainz, Germany
  • 2Institute of Pathology, Johannes Gutenberg University Mainz, Germany
  • 3Institute of Medical Statistics, Epidemiology and Informatics, Johannes Gutenberg University Mainz, Germany
Weitere Informationen

Publikationsverlauf

submitted 11 July 2008

accepted after revision 20 November 2008

Publikationsdatum:
12. Februar 2009 (online)

Background and study aims: Patients with gastroesophageal reflux disease are subdivided into non-erosive (NERD) and erosive reflux disease (ERD). The newly available EPKi processor enables high-definition resolution above HDTV standard (HD+). The aim of the study was to test the efficacy of HD+ esophagogastroduodenoscopy alone and in conjunction with i-Scan (newly developed postprocessing digital filter) and chromoendoscopy (Lugol’s solution) for differentiation of reflux patients.

Methods: The distal esophagus of patients with heartburn was inspected with three imaging modalities. HD+ was followed by i-Scan and 15-mL Lugol’s solution (1.5 %). The esophagus was evaluated for mucosal breaks (Los Angeles Classification [LA]). Small visible changes were also characterized, and targeted biopsies were performed. End points of the study were the presence and grade of esophagitis and the number of circumscribed changes.

Results: A total of 50 patients were included (female 29; mean age 54.7 years). HD+ identified nine patients with mucosal breaks (LA 7A; 2C), i-Scan was able to detect 12 patients (LA 8A; 2B; 2C; 0D) (P = n. s.) and chromoendoscopy identified 25 patients (LA 16A; 7B; 1C, 1D) (P < 0.01). Furthermore, a higher grade of esophagitis was recognized by using i-Scan and Lugol’s solution in 19 patients. The number of circumscribed lesions could be increased from 21 (HD+) to 58 (i-Scan) (P < 0.01), and up to 85 after Lugol spraying (P < 0.01).

Conclusions: Lugol’s solution in conjunction with HD+ endoscopy significantly improves the identification of patients with esophagitis and reduces misclassification. The i-Scan filter and chromoendoscopy help to identify reflux-associated lesions.

References

  • 1 Richter I E. Typical and atypical presentations of gastroesophageal reflux disease The way of esophageal testing in diagnosis and management.  Gastroenterol Clin North Am. 1997;  25 75-102
  • 2 Dent J, El-Serag H B, Wallander M A, Johansson S. Epidemiology of gastro-oesophageal reflux disease: a systematic review.  Gut. 2005;  54 710-717
  • 3 Armstrong D. Endoscopic evaluation of gastro-esophageal reflux disease.  Yale J Biol Med. 1999;  72 93-100
  • 4 Lundell L R, Dent J, Bennet J. et al . Endoscopic assessment of esophagitis: clinical and functional correlates and further validation of the Los Angeles classification.  Gut. 1999;  45 172-180
  • 5 Kusano M, Kyoko I, Yamada T. et al . Interobserver and intraobserver variation in endoscopic assessment of GERD using the “Los Angeles” classification.  Gastrointest Endosc. 1999;  49 700-704
  • 6 Zagari R M, Pozzato P, Damian S. et al . Relationship between gastroesophageal reflux symptoms and esophagitis in the general population: results from the Loiano-Monghidoro study.  Gastroenterology. 2006;  130 T1018
  • 7 Lagergren J. Adenocarcinoma of oesophagus: what exactly is the size of the problem and who is at risk?.  Gut. 2005;  54 Suppl 1 i1-i5
  • 8 El-Serag H B. Temporal trends in new and recurrent esophageal strictures in the Department of Veterans Affairs.  Am J Gastroenterol. 2006;  101 1727-1733
  • 9 Ruigómez A, García R odríguez, Wallander M A. et al . Natural history of gastro-esophageal reflux disease diagnosed in UK general practice.  Aliment Pharmacol Ther. 2004;  20 751-760
  • 10 Lind T, Havelund T, Carlsson R. et al . Heartburn without oesophagitis: efficacy of omeprazole therapy and features determining therapeutic response.  Scand J Gastroenterol. 1997;  32 974-979
  • 11 Jones R H, Hungin A DS, Phillips J. et al . Gastroesophageal reflux disease in primary care in Europe: clinical presentation and endoscopic findings.  Eur J Gen Pract. 1995;  1 149-154
  • 12 Martinez S D, Malagon I B, Garewal H S. et al . Non-erosive reflux disease (NERD) – acid reflux and symptom patterns.  Aliment Pharmacol Ther. 2003;  15 537-545
  • 13 Dent J, Brun J, Fendrick M. et al . An evidence-based appraisal of reflux disease management – The Genval Workshop report.  Gut. 1999;  44 1-16
  • 14 Voegeli R. Schiller’s iodine test in the diagnosis of esophageal diseases. Preliminary report [Article in German].  Pract Otorhinolaryngol (Basel). 1966;  28 230-239
  • 15 Brodmerkel G J. Schiller’s test, an aid in esophagoscopic diagnosis [abstract].  Gastroenterology. 1971;  60 813
  • 16 Endo M, Takeshita K, Yoshida M. How can we diagnose the early stage of esophageal cancer?.  Endoscopy. 1986;  18 Suppl 3 11-8
  • 17 Mori M, Adachi Y, Matsushima T. et al . Lugol staining pattern and histology of esophageal lesions.  Am J Gastroenterol. 1993;  88 701-705
  • 18 Witt H, Watanabe M, Slezak P, Rubio C. The significance of mucosal staining for the endoscopic diagnosis of chronic esophagitis as assessed in biopsy findings.  Hepatogastroenterology. 1994;  41 564-567
  • 19 Misumi A, Kondou H, Murakami A. et al . Endoscopic diagnosis of reflux esophagitis by the dye-spraying method.  Endoscopy. 1989;  21 1-6
  • 20 Gono K, Obi T, Yamaguchi M. et al . Appearance of enhanced tissue features in narrow-band endoscopic imaging.  J Biomed Opt. 2004;  9 568-577
  • 21 Sharma P, Wani S. Advances in esophageal imaging: practical applications for clinicians.  Rev Gastroenterol Disord. 2006;  6 Suppl 1 12-18
  • 22 Mori M, Adachi Y, Matsushima T. et al . Lugol staining pattern and histology of esophageal lesions.  Am J Gastroenterol. 1993;  88 701-705
  • 23 Weigt J, Mönkemüller K, Kolfenbach S, Malfertheiner P. Standards and innovations in the diagnosis of gastroesophageal reflux disease.  Z Gastroenterol. 2007;  45 1141-1149
  • 24 Dimenüs E. Methodological aspects of evaluation of quality of life in upper gastrointestinal diseases.  Scand J Gastroenterol. 1993;  28 18-21
  • 25 Fass R, Fennerty B, Vakil N. Nonerosive reflux disease – current concepts and dilemmas.  Am J Gastroenterol. 2001;  96 303-314
  • 26 Fass R, Ofmann J, Sampliner R. et al . The omeprazole test is as sensitive as 24-h esophageal pH monitoring in diagnostic gastro-esophageal reflux disease in symptomatic patients with erosive esophagitis.  Aliment Pharmacol Ther. 2000;  14 389-396
  • 27 Olden K, Triadafilopoulos G. Failure of initial 24-hour esophageal pH monitoring to predict refractoriness and intractability in reflux esophagitis.  Am J Gastroenterology. 1991;  86 1141-1146
  • 28 Mitooka H, Fujimori T, Maeda S. et al . Colon polyp detected by contrast chromoscopy using indigo carmine dye capsule.  Dig Endosc. 1992;  4 340-354
  • 29 Kudo S, Tamura S, Nakajima T. et al . Diagnosis of colorectal tumorous lesions by magnifying endoscopy.  Gastrointest Endosc. 1006;  44 8-14
  • 30 Kiesslich R, Hahn M, Herrmann G, Jung M. Screening for specialized columnar epithelium with methylene blue: chromoendoscopy in patients with Barrett’s esophagus and a normal control group.  Gastrointest Endosc. 2001;  53 47-52
  • 31 Canto M I, Setrakian S, Petras R E. et al . Methylene blue selectively stains intestinal metaplasia in Barrett’s esophagus.  Gastrointest Endosc. 1996;  44 1-7
  • 32 Endo T, Awakawa T, Takahashi H. et al . Classification of Barrett’s epithelium by magnifying endoscopy.  Gastrointest Endosc. 2002;  55 641-647
  • 33 Hoffman A, Kiesslich R, Bender A. et al . Acetic acid-guided biopsies after magnifying endoscopy compared with random biopsies in the detection of Barrett’s esophagus: a prospective randomized trial with crossover design.  Gastrointest Endosc. 2006;  64 1-8
  • 34 Yoshikawa I, Yamasaki M, Yamasaki T. et al . Lugol chromoendoscopy as a diagnostic tool in so-called endoscopy-negative GERD.  Gastrointest Endosc. 2005;  62 698-703
  • 35 Kiesslich R, Kanzler S, Vieth M. et al . Minimal change esophagitis: prospective comparison of endoscopic and histological markers between patients with non-erosive reflux disease and normal controls using magnifying endoscopy.  Dig Dis. 2004;  22 221-227
  • 36 Sharma P, Wani S, Bansal A. et al . A feasibility trial of narrow band imaging endoscopy in patients with gastroesophageal reflux disease.  Gastroenterology. 2007;  133 454-464
  • 37 Mori M, Adachi Y, Matsushima T. et al . Lugol staining pattern and histology of esophageal lesions.  Am J Gastroenterol. 1993;  88 701-705
  • 38 Inoue H, Rey J F, Lightdale C. Lugol chromoendoscopy for esophageal squamous cell cancer.  Endoscopy. 2002;  33 75-79
  • 39 Kiesslich R, Hoffman A, Neurath M F. Colonoscopy, tumors, and inflammatory bowel disease – new diagnostic methods.  Endoscopy. 2006;  38 5-10
  • 40 Hoffman A, Jung M, Neurath M F, Kiesslich R. Detection of colorectal cancer and pre-malignant conditions with chromo- and magnifying endoscopy.  Acta Endoscopica. 2005;  35 581-596
  • 41 Dent J, Brun J, Fenrick A M. et al . An evidence-based appraisal of reflux disease management. The Genval workshop report.  Gut. 1999;  44 Suppl 29 1S-16S
  • 42 Weinstein W M. The prevention and treatment of dysplasia in gastroesophageal reflux disease: the results and the challenges ahead.  J Gastroenterol Hepatol. 2002;  17 113-124
  • 43 Lanzafame S, Torrisi A, Favara C. et al . Correlation between intestinal metaplasia of the gastric cardia and gastroesophageal reflux disease.  Hepatogastroenterology. 2001;  48 1007-1010

A. HoffmanMD 

I. Med. Clinic
Johannes Gutenberg University of Mainz

Langenbeckstr. 1
55101 Mainz

Fax: +49-6131-175552

eMail: AHoff66286@aol.com